Posterior Blepharitis and Associated Potential Factors: A Study among Pregnant Women

Impact of meibomian gland dysfunction on quality of life and mental health in a clinical sample in Ghana: a cross-sectional study

OBJECTIVES

This study aimed to determine the impact of meibomian gland dysfunction (MGD) on quality of life and psychosomatic conditions.

DESIGN

This was a clinic-based cross-sectional study.

SETTING

This study was conducted at the eye clinic of the University of Cape Coast, Ghana.

PARTICIPANTS

215 clinical subjects visiting the clinic for a comprehensive eye examination.

PRIMARY AND SECONDARY OUTCOME MEASURES

Symptomatic MGD, asymptomatic MGD, quality of life scores, depression, anxiety and stress.

RESULTS

215 clinical subjects consented to participate in the study, but 212 were included in the analysis. The mean age was 21.9 (± 3.8) years, 54 had MGD and 158 did not have MGD served as controls. There was no statistically significant difference in the mean quality of life scores between subjects with MGD and subjects without MGD (t=1.57, p=0.12). The quality of life scores (DEQS) (p=0.022) were significantly higher in the symptomatic MGD group compared with the asymptomatic MGD group. There was no significant difference in quality of life scores (DEQS) (p=0.251) in the asymptomatic MGD group compared with healthy controls. Using Pillai's trace in the MANOVA, there was a significant effect of MGD on depression, anxiety and stress (V=0.05, F(3,208)=3.76, p=0.012). Furthermore, Pillai's trace in the MANOVA showed a significant difference between asymptomatic and symptomatic MGDs for depression, anxiety and stress scores stress (V=0.24, F(3, 51)=5.24, p=0.003).

CONCLUSION

The study revealed no difference in the quality of life scores between MGD and non-MGD groups. However, the symptomatic MGD group had worse quality of life and psychosomatic symptoms than the asymptomatic MGD group and non-MGD group.

Bevacizumab Eye Drops Vs. Intra-meibomian Gland Injection of Bevacizumab for Meibomian Gland Dysfunction-Associated Posterior Blepharitis

Aims

This study aimed to evaluate the efficacy and safety of bevacizumab eye drops compared with those of an intra-meibomian gland (MG) injection of bevacizumab when performed in conjunction with standard lid hygiene in patients with meibomian gland dysfunction (MGD)-associated posterior blepharitis.

Methods

This prospective, open-label, observer-blinded randomized controlled trial included 60 eyes of 30 patients with MGD-associated posterior blepharitis who exhibited lid margin telangiectasia, treated at the Chula Refractive Surgery Center of King Chulalongkorn Memorial Hospital. Patients were randomized to receive lid hygiene plus 0.05% bevacizumab eye drops or a single intra-MG injection of 2.5% bevacizumab. All patients were instructed to perform routine lid hygiene care as demonstrated in an instructional video. Primary outcomes included telangiectasia grading and the lid margin neovascularized area (LMNA). Secondary outcomes included the Ocular Surface Disease Index (OSDI) score, corneal staining, meibum quality, meiboscore, conjunctival redness, fluorescein break-up time (FBUT), lipid layer thickness, treatment compliance, and adverse events. All parameters were evaluated before and 3 months after treatment.

Results

After treatment, there were no significant differences in telangiectasia grade and LMNA between groups (mean difference, −0.14, 95% CI −0.42 to 0.15, p = 0.338, −0.1, 95% CI −1.1 to 0.8, p = 0.761, respectively); however, the injection group exhibited significant improvements in both telangiectasia grade and LMNA, while, in the eye drop group, only telangiectasia grade showed a significant improvement relative to baseline. The injection group also exhibited significant improvements in corneal staining (mean difference, −0.78, 95% CI −1.29 to −0.27, p = 0.003), meiboscores (mean difference, −0.37, 95% CI −0.52 to −0.21, p <0.001), and FBUT (mean difference, 1.25, 95% CI 0.21–2.29, p = 0.019) compared to the eye drop group. OSDI scores, corneal staining, meibum quality, meiboscores, and conjunctival redness significantly improved relative to baseline in both groups. No local and systemic adverse event was observed at month 3 in both groups.

Conclusion

When performed with regular lid hygiene, intra-MG injection and topical application of bevacizumab are safe and effective for improving lid margin telangiectasia and the signs and symptoms of MGD-associated posterior blepharitis. This therapy may represent an alternative or adjunctive treatment for patients with MGD-associated posterior blepharitis.

Improved Watershed Algorithm-Based Microscopic Images Combined with Meibomian Gland Microprobe in the Treatment of Demodectic Blepharitis

The objective of the study was to explore microscopic images under a watershed segmentation algorithm combined with meibomian gland microprobe in the treatment of demodectic blepharitis. For segmenting the connected target objects in the image, the watershed algorithm was utilized first to obtain the target region in the image, and then, the fuzzy C-means (FCM) clustering algorithm was used to cluster the targets. The different grayscale regions in the microscopic images were segmented. 90 patients with demodectic blepharitis-related dry eyes were selected, and they were divided into experimental group 1 (group E1, n = 30), experimental group 2 (group E2, n = 30), and control group (group CG, n = 30). The breakup time (BUT) of the tear film, the subjective score of clinical symptoms, and the number of mites were compared among the three groups before and after treatment. The results showed that after treatment, the indicators of group E1 and group E2 were significantly lower than those before treatment, and the differences were statistically significant (P < 0.05). The treatment effect of group E1 was significantly better than that of the other two groups (P < 0.05). The subjective clinical symptom scores of groups E1, E2, and CG were 13.43 ± 1.41, 13.51 ± 1.41, and 13.64 ± 0.84, respectively, before treatment, and those after treatment were 3.1 ± 1.841, 5.4 ± 0.661, and 13.4 ± 0.841, respectively. The clinical sign scores of the groups E1 and E2 after treatment were remarkably different from those before treatment (P < 0.05). Compared with the scores of clinical signs and clinical symptoms after treatment, those of group E1 showed the largest differences, indicating the best treatment effect. In conclusion, the treatment effect of blepharitis could be promoted with the improved watershed algorithm, and the microscopic images combined with meibomian gland microprobe gave the better effect in the treatment of demodectic blepharitis than the conventional drug heat compress.

Candidate Molecular Compounds as Potential Indicators for Meibomian Gland Dysfunction

Meibomian gland dysfunction (MGD) is the leading cause of dry eye disease throughout the world. Studies have shown that several molecules in meibum, including but not limited to interleukins, amino acids, cadherins, eicosanoids, carbohydrates, and proteins, are altered in meibomian gland dysfunction compared with healthy normal controls. Some of these molecules such as antileukoproteinase, phospholipase A2, and lactoperoxidase also show differences in concentrations in tears between meibomian gland dysfunction and dry eye disease, further boosting hopes as candidate biomarkers. MGD is a complex condition, making it difficult to distinguish patients using single biomarkers. Therefore, multiple biomarkers forming a multiplex panel may be required. This review aims to describe molecules comprising lipids, proteins, and carbohydrates with the potential of serving various capacities as monitoring, predictive, diagnostic, and risk biomarkers for meibomian gland dysfunction.

Meibomian Gland Dysfunction and Lipid Profile: A Study Among Pregnant Women

PURPOSE

This study aimed to estimate the frequency of meibomian gland dysfunction (MGD) and its associated factors among pregnant women.

METHODS

This was a hospital-based cross-sectional study of consecutive pregnant women visiting the University of Cape Coast hospital's antenatal clinic. Meibomian gland assessment and tear function test were performed along with the administration of a symptom questionnaire. Correlation, analysis of variance, and logistic regression analyses were used to examine predictors of MGD.

RESULTS

All 201 pregnant women who met the inclusion criteria and gave informed consent were included in the study. The mean age of the entire sample was 29.96 (±4.74) years. The frequency of MGD among the cohort of pregnant women was 22.9% (95% confidence interval, 17.4%-28.9%). Univariate logistic regression revealed that the following factors were significantly associated with MGD: high-density lipoprotein (HDL) (odds ratio [OR] 1.017; 95% confidence interval [CI], 1.001-1.034; P=0.042), total cholesterol (TC) (OR 1.009; 95% CI, 1.003-1.016; P=0.006), and low-density lipoprotein (LDL) (OR 1.008; 95% CI, 1.00-1.016; P=0.049). In multivariate analysis, the model confirmed that MGD was not significantly associated with TC, LDL, and HDL.

CONCLUSIONS

In summary, this study showed a high frequency of MGD in pregnant women but comparable with that reported in the normal population. Clinicians examining pregnant women for dry eye disease may need to pay attention to other causative instigators aside MGD to enable the clinicians to make an appropriate etiology-based diagnosis.